Elder abuse is a serious problem. It is important to remember that the types of abuse that were outlined above are not only cruel and immoral, they are illegal. Each state has its own laws about who is required to report elder abuse, but it is almost certain that no matter where you are working a CNA must report elder abuse if you know or strongly suspect it is happening. In some states private citizens with no medical training may not be required to report elder abuse. But as a medical professional you are legally obligated to report such situations. How is this done?

• If someone is in immediate danger or a crime has just been committed, call 911 or the local police.

• If you suspect some form of elder abuse is occurring, but the danger is not immediate, call or notify your immediate supervisor.

• Every state has a toll-free elder abuse hotline. In most states the Adult Protective Services are responsible for handling cases of elder abuse. You can find the Adult Protective Services office in your area through the National Adult Protective Services Association (NAPSA) website: http://www.napsa-now.org/. The NAPSA can also be reached at 217-523-4431.

• If a supervisor is not easily reached or you do not know who to call in your area, you can call The Eldercare Locator at 1-800-677-1116. This service is sponsored by the U.S. Administration on Aging. It is available Monday through Friday, 9 am to 8 pm, Eastern Time. They can help you locate the appropriate agency in your area that is involved in managing cases of elder abuse. Also, the National Center on Elder Abuse (NCEA) has a website that is an excellent source of information. The website has state by state listings of the names and telephone numbers of the appropriate agencies that can help prevent, treat, and report elder abuse. The website address is: www.ncea.aoa.gov, and the telephone number is 1-855-500-3537. Another source of information is the blue pages of your local telephone directory.

If elder abuse is occurring, it is your duty and your legal obligation to report it. It is very important, however, that you have a reasonable suspicion that abuse is actually happening. Don’t decide that an elderly person is being abused on the basis of your feelings or intuition. Make sure that your suspicions are based on objective information that can be observed, documented, and verified.

You don’t need hard evidence in order to report elder abuse or suspected elder abuse. That is, you don’t need to witness the abuse and the abuse does not have to be dramatic. But if there are signs that elder abuse may be occurring, then the appropriate agency should be notified and an investigation can be done. Again, be specific when you report a potential case of elder abuse. It’s not enough to say, “Mr. Jones doesn’t look healthy and he doesn’t seem to take care of himself.” Instead, use objective data: “Mr. Jones is always dressed in the same clothes, he doesn’t appear to have bathed in a long time, and he is limping and seems to be in pain all the time. He seems fearful and withdrawn, especially around his relatives, and when I ask him about his personal hygiene, the limp, and his emotional state, he either will not answer or provides answers that are evasive in nature.”

Should You Ask an Elderly Person if She/He is Being Abused?

There are situations in which elder abuse has clearly happened or situations in which there are obvious warning signs that it might be happening. In that case, as a healthcare professional you have an obligation to ask that person if she/he has been abused.

But what if you merely have a slight suspicion that abuse is occurring? Should you ask that person and if so, how do you ask? And given that that elder abuse is very common, very under reported, and may not be obvious, doesn’t it make sense to at least open the subject with every elderly patient?

There are no easy answers to these questions. The American Medical Association recommends that all physicians routinely ask elderly patients about abuse, even if there are no obvious signs that abuse might be occurring. However, there is no universal agreement in the health care community about the best way to screen for abuse in the elderly population.

The most sensible approach would be to follow the guidelines that have been developed by your workplace, and if you are required to ask about abuse do so in a way that is non-confrontational, non-judgmental, and supportive. You should also assess each situation and determine the best way to open the subject. Remember, this is a very sensitive issue. An elderly person may be suffering abuse, but it is most often from a relative or some other person, with whom the elderly person has emotional or social ties, so admitting to a stranger that abuse is happening is not easy. A direct question such as “Is your son abusing you?” or “Are you afraid of anyone who is taking care of you?” could be too abrupt and intrusive for many people. In most cases it would be better to simply say “How is everything going at home?” or “How are you getting along with everybody? Any problems?” and then listen and watch closely as to how that person responds.

You can also “let your conscience be your guide” and realize that your responsibility is to keep your patients safe, not to provide a solution to a problem: you are only trying to determine if abuse is or could be happening, not correct the situation. That means that you may not need to directly ask someone if abuse is occurring and directly intervene, but if you feel there is a possibility – even if there are no obvious signs of abuse – you can bring your concerns to a supervisor, social worker, or elder advocate.